Safety concerns about the application of moxa

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<ul><li><p>J. Acupunct. Tuina. Sci. 2010, 8 (3): 145-148 DOI: 10.1007/s11726-010-0393-0 </p><p> Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 145 </p><p>Special Topic for 973 Program</p><p>Safety Concerns about the Application of Moxa </p><p>LI Jun (), ZHAO Bai-xiao () College of Acupuncture and Tuina, Beijing University of Traditional Chinese Medicine, Beijing 100029, P. R. China </p><p>: AbstractObjective: To discuss the safety issues of moxibustion therapy in view of moxibustion materials. Methods: The analyses and assessment were performed based on the survey carried out on the use of moxa, modern and ancient records, modern studies, and clinical applications. Results: Moxa has been used as both a medicine and a food for a long history in China. Regarding moxibustion specifically, moxa has been proven to be the optimum choice for moxibustion therapy, through practices and experiments by doctors from different generations. No records have shown any side- or adverse-effects of moxa applied in moxibustion therapy. Conclusion: Moxa has been used in multiple ways for several thousands of years by Chinese people. As the main material for moxibustion therapy, its safety has been proven by documents and clinical practices. Key WordsMoxa; Moxibustion Therapy; Moxa Floss; Moxa Cone; Moxa Stick; Moxibustion Materials CLC NumberR245.8 Document CodeA </p><p>Moxibustion is an external therapy to warm qi and blood, strengthen healthy energy and expel pathogens. This is carried out through the action of warm stimulation and the use of medical herbs, with the moxa fluff as the main material smoldered at acupoints or the affected area [1]. Moxa is most frequently used in moxibustion therapy, which has been created, developed and improved gradually over thousands of years of fighting against disease. Moxibustion has played an important role in traditional Chinese medicine, as it has been adopted in various aspects, such as in treatment of diseases, health maintenance, and longevity. However, problems still exist in the promotion of the </p><p>Fund Item: National Basic Research Program of China (973 Program, 2009CB522906) Author: LI Jun (1985- ), male, postgraduate for master degree Correspondence Author: ZHAO Bai-xiao (1963- ), male, professor, doctorial supervisor </p><p>application of moxibustion therapy after so many years clinical practice, because people doubt effect of the smoke produced by moxibustion as well as the inconvenience of application. It has been recorded that the use of branches and straws for moxibustion predated moxa, but why did the medical practitioners choose moxa to be the best moxibustion material? Is it safe? Is it possible that the smoke produced by moxibustion is harmful to human beings? The author will discuss moxibustion therapy based on these questions. </p><p> 1 Artemisia Argyis Application in Daily life </p><p> Artemisia Argyi is used in a variety of ways and </p><p>its history can be traced back to ancient times. The record of Artemisia Argyi was first found in the Book of Songs (Shi Jing), the first collection of poems in China, in the Spring and Autumn Period </p></li><li><p>J. Acupunct. Tuina. Sci. 2010, 8 (3): 145-148 </p><p> 146 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 </p><p>(770 B.C.-476 B.C. ). In Li Sao created in Warring States Period (475 B.C-221 B.C.), Artemisia Argyi was also mentioned. It indicates that this plant has been widely used in the daily life of Chinese people. Artemisia Argyi is edible. Its cooking methods and functions were first introduced in Shi Liao Ben Cao (written by MENG Xian, Tang Dynasty), and it can be used to make pastry or decoction against trauma, metrorrhagia, cholera, and bleeding during pregnancy. </p><p>During spring in the southern area of China, Artemisia Argyi is a commonly seen in food. After rinsing, peering off stem and dead leaves, people mix Artemisia Argyi with flour in specific proportions to make steamed bread, dumplings, cakes, or mixed with rice to make sticky rice cakes. It can also be processed into tea or wine[2]. In rural areas, Artemisia Argyi is smoldered for sterilization in the labor room, as it can purify air, drive away mosquitoes, kill bacteria, molds and viruses[3]. On Dragon-Boat Festival, the fifth day of the fifth lunar month, people will counteract evil forces or poisonous substance by hanging up the plant, or taking or bathing in its decoction. </p><p> 2 Moxas Application in Medical Activities </p><p>Moxa is the dried leaves of Artemisia Argyi. Its picked in summer before blossom, dried in sunshine. Its soft and fragrant, bitter and spicy in taste, warm and a little bit poisonous in nature, entering the meridians of liver, spleen and kidney. It can activate the release of cold and pain, warm meridians and stop bleeding, so its used in the management of cold pain in the lower abdomen, sterility or irregular menstruation due to cold retained in meridians or uterus, hematemesis, rhinorrhagia, metrorrhagia, bleeding during pregnancy, and external application for pruritus cutanea, 3-9 g being the common dose[4]. The first record of moxa used in medical ways was in the Wu Shi Er Bing Fang (Fifty-two Prescriptions) written around the Warring States Period[5]. It was also mentioned in the Huang Di Nei Jing (Yellow Emperors Inner Cannon). In Ben Cao Gang Mu (the Compendium of Materia Medica), it said that the moxa was bitter, slightly warm, nonpoisonous in nature, activating both descending and ascending directions, belonging to yang and entering the </p><p>meridians of spleen, liver and kidney. People in previous times considered the moxa to be poisonous. But the author LI Shi-zhen confuted this view in this book[6]. He believed that the side and adverse effects after taking moxa was not from the herb itself but from taking it in excess. It has enrolled 52 prescriptions with composition of moxa in Ben Cao Gang Mu. For example, the famous prescription Jiao Ai Si Wu Tang was used for metrorrhagia, bleeding during pregnancy, and Ai Fu Nuan Gong Wan for irregular menstruation, dysmenorrheal and lumbar pain during menstruation period, and sterility due to cold retained in uterus. </p><p> 3 Moxas Application in Moxibustion </p><p> Its been a long history for moxa being used in </p><p>moxibustion therapy. Ever since the time of Ling Shu (Spiritual Pivot), moxa had been used for moxibustion and the word Ai (Artemisia Argyi) was used in place of Jiu (moxibustion), thus forming up the word Ai Jiu (moxibustion therapy) we are using today. In ancient time, besides moxa, other herbs such as mulberry twig and peach branchlet were also used for moxibustion therapy. These materials were gradually eliminated for all kinds of limitations. However, moxa has survived and developed after selection of several thousands of years. To analyze the reason, its not only related to its healing function and fragrance, but also its ability to ignite, to burn thoroughly, and its good kindling function[7]. </p><p>In clinical practice, moxibustion therapy is not supplied directly with the leaf, but with the moxa stick or moxa cone made by processed moxa fluff. The aged moxa fluff is usually considered to be the best for moxibustion therapy as the heat produced by the fresh moxa is too strong for the therapy. </p><p> 4 Chemical Compositions, Pharmacological </p><p>Effects and Clinical Application of Moxas Essential Oil JIN Ran et al,[8] extracted oil from Artemixia </p><p>Argyi leaves of different ages with steam distillation, and adopted GC-MS technique to determine the nature for semi-quantitative analysis. It detected the same contents of high concentration, such as eudesmol, thujone, chrysanthenone, camphor, </p></li><li><p>J. Acupunct. Tuina. Sci. 2010, 8 (3): 145-148 </p><p> Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 147 </p><p>borneol, terpinen-4-ol, caryophyllene, oleanolicacid and juniper camphor, in different aged Artemisia Argyi (from the year 2007, 2008 and 2009). The chemical components of different aged Artemisia Argyi are similar but with various concentrations. The aged leaves usually contain less volatile but more steady components. XIE Qiang-min, et al[9] observed the bronchodilating action of the essential oil of Artemisia Argyi during the remittent stage of asthma. It found that the essential oil and spray can protect a guinea pig from asthma induced by histamine and acetycholine, and significantly extend the remittent stage of asthma. HUANG Xue-hong, et al[10] observed antitussive and expectorant effect of the essential oil of Artemisia Argyi in mice. Its reported that the essential oil can inhibit the pathogens in vitro, prolong the remittent stage of a cough, and decrease the pulmonary overflow pressure, indicating that the oils bear the function of killing and inhibiting bacteria. They have an antitussive function as well as an expectorant and anti-asthmatic. SUN Jing-kui, et al[11] observed the anti-asthmatic effect of the essential oil extracted from Artemisia Argyi in 12 patients with asthma, and found in 10 cases that symptoms were relieved and 2 cases improved. In recent years, Artemisia Argyi has been used in aromatherapy[12]. </p><p> 5 Modern Study on Chemical Compositions </p><p>of the Smoke Produced by Moxibustion During moxibustion, the smoldered moxa fluff </p><p>can produce large amount of smoke, which consists of multiple compounds, including essential oils, suspended granules and products from chemical oxidation reaction. In modern studies, it took solid phase micro-extraction and gas collection techniques to collect the smoke samples and analyze the chemical components with GC-MS. HONG Zong-guo, et al[13] used benzyl alcohol and butanol for extraction, and got 25 and 31 components respectively after GC-MS analysis, most were aliphatic hydrocarbons, aromatic hydrocarbons and terpenoids. So far, most studies have been mainly associated with composition identification. The quantitative study on each component is still under exploration. It still needs systemic research to determine whether the chemical components contain poisonous elements. </p><p>6 Ancient Records about the Safety of Moxibustion Therapy The records in ancient literature usually talked </p><p>about the contraindications of moxibustion therapy, but never mentioned the harm of the smoke during moxibustion. In the Zhen Jiu Jia Yi Jing (A-B Canon of Acupuncture and Moxibustion, it put forward 24 acupoints where moxibustion therapy should be avoided. As it usually refers to direct moxibustion, acupoints located on face should all be avoided. With the development of moxibustion techniques, the operators now can well-control the heated area and temperature, and almost every acupoint can receive moxibustion therapy, except areas such as the face should avoid direct moxibustion. </p><p> 7 Discussion </p><p>In a word, based on the clinical practice over thousands of years, it suggests that its safe to say that Artemisia Argyi, and its essential oils, have anti-asthma, cough-relieving and phlegm-resolving functions. As it is safe to make Artemisia Argyi into food, it somehow indicates that its also safe to put moxa cones on the skin for moxibustion. The heat, light, and moxa smoke produced during moxibustion form up the three major elements of action. Modern clinical and experimental studies all find that heat and light are the main constituents of moxibustion. Its comparatively safe if the operation is correct, though it may produce some poisonous substances. However the concentrations of the poisonous substances are usually low. On the other hand, if the smoke was harmful to the human body, moxibustion practitioners of previous generations would have been affected by it, and moxibustion therapy would not have succeeded and developed as much as it has. </p><p> 8 Conclusion </p><p>According to ancient and modern literature, studies and clinical practice, its safe to adopt Artemisia Argyi as moxibustion material for healing and health maintenance. However, it requires more in depth clinical and experimental studies to examine the safety criteria for moxibustion therapy. </p></li><li><p>J. Acupunct. Tuina. Sci. 2010, 8 (3): 145-148 </p><p> 148 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 </p><p>References </p><p>[1] LU Shou-kang. Acupuncture &amp; Moxibustion Therapy. Beijing: China Press of Traditional Chinese Medicine, 2003: 87-88 </p><p>[2] ZHENG Han-chen, WEI Dao-zhi, HUANG Bao-kang, et al. Advances in Ethnobotanic and Modern Pharmaceutic Studies on Folium Artemisiae Argyi. The Chinese Academic Medical Magazine of Organisms, 2003, (3): 36. </p><p>[3] JIANG Wen-quan, CUI Cai-ping. Smoldering Artemisia Argyi for Rooming-in Sterilization. Northwest Pharmaceutical Journal, 2002, 17(2): 80-81. </p><p>[4] China Pharmacopoeia Committee. Pharmacopoeia of P.R.China. Beijing: Chemical Industry Press, 2005: 61. </p><p>[5] Silk Books from a Tomb at Mawangdui. Fifty-two Prescriptions. Beijing: Cultural Relics Press, 1979: 79, 93. </p><p>[6] LI Jing-wei, LI Zhen-ji. Notes of Compendium of Matreia Medica. Shenyang: Liaohai Publishing House, 2000: 583-584. </p><p>[7] QI Hao. The Developing Progress of Artemisia Argyi and Moxibustion. Forum on Traditional Chinese Medicine, 1989, (1): 37. </p><p>[8] JIN Ran, YU Mi-mi, ZHAO Bai-xiao, et al. Study on Chemical Compounds of Artemisia Argyi of Different Years and Moxa Fluff of Different Proportion. Chinese </p><p>Acupuncture &amp; Moxibustion, 2010, 30(5): 40-42. [9] XIE Qiang-min, BIAN Ru-lian, YANG Qiu-huo, et al. </p><p>Studies on the respiratory pharmacology of essential oil extracted from Artemisia Argyi- ,Bronchodilating, antitussive and expectorant effects. Chinese Journal of Modern Applied Pharmacy, 1999, 16(4): 16. </p><p>[10] HUANG Xue-hong, XIE Yuan-de, ZHU Wan-ping, et al. Experimental Study on the Oil Extracted from Artemisia Argyi in Management of Chronic Bronchitis. Zhejiang Journal of Traditional Chinese Medicine, 2006, 41(12): 734. </p><p>[11] SUN Jing-kui, SUN Na, SUN Xiu-yun, et al. Observation on the Anti-asthma Effect of Oil Extracted from Artemisia Argyi Taken by Inhaling. Journal of Practical Traditional Chinese Internal Medicine, 1989, 3(4): 22. </p><p>[12] MEI Jia-qi. Safety Evaluation for Aromatherapy Product Standards. Flavour Fragrance Cosmetics, 2009, 4(2): 55. </p><p>[13] HONG Zong-guo, NONG Yi-ying, YANG Zhao-tao, et al. QIAI Burning Smoke GC-MS Analysis of the Chemical Composition. Journal of South Central University for Nationalities (Natural Science Edition), 2007, 26(1): 10. </p><p>Translator: HONG Jue () Received Date: March 27, 2010</p><p>Shanghai Research Institute of Acupuncture and Meridian One of the largest research organizations of acupuncture and meridian in China, founded in 1958; Possesses a group of specialists capable of clinical and experimental research, and teaching; Studying in depth acupuncture treatment for diseases of immune, nerve, endocrine, digestive, </p><p>urinary and genital systems; </p><p> Undertakes responsibility of WHO research projects and is bed-side teaching unit for domestic and foreign students, visiting scho...</p></li></ul>